Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data

Nai Fang Chi, Chi Pang Wen, Chung Hsiang Liu, Jie Yuan Li, Jiann Shing Jeng, Chih Hung Chen, Li Ming Lien, Ching Huang Lin, Yu Sun, Wei Lun Chang, Chaur Jong Hu, Chung Y. Hsu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Clopidogrel was thought to be superior to aspirin for secondary prevention of vascular diseases in clinical trials. In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real-world practice by using the Taiwan Stroke Registry. Methods and Results Patients with ischemic stroke (2006-2016) on aspirin or clopidogrel for secondary stroke prevention were identified in the Taiwan Stroke Registry. Stroke recurrence and mortality rates in patients receiving aspirin (N=34 679) were compared with those receiving clopidogrel (N=7611) during a 12-month follow-up period. Propensity score matching and conditional Cox proportional hazards regression model were applied to control confounding factors with 6443 patients in each group. After propensity score matching, stroke recurrence rates were comparable between groups, with 223 patients in the aspirin (3.46%) and 244 in the clopidogrel group (3.79%) (hazard ratio=1.13, 95% confidence interval=0.89-1.43, P=0.311). However, the mortality rate was significantly higher in the clopidogrel group (362 patients, 5.62%) than in the aspirin group (302 patients, 4.69%) (hazard ratio=1.30, 95% confidence interval=1.07-1.58, P=0.008). Results were consistent before and after propensity score matching. Conclusions Clopidogrel was as effective as aspirin for prevention of recurrent stroke in real-world practice. However, the mortality rate was significantly higher in the clopidogrel than in the aspirin group.
Original languageEnglish
Pages (from-to)e009856
JournalJournal of the American Heart Association
Volume7
Issue number19
DOIs
Publication statusPublished - Oct 2 2018

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clopidogrel
Secondary Prevention
Aspirin
Stroke
Propensity Score
Taiwan
Registries
Mortality
Confidence Intervals
Recurrence
Vascular Diseases
Proportional Hazards Models

Keywords

  • aspirin
  • clopidogrel
  • prevention
  • stroke

Cite this

Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data. / Chi, Nai Fang; Wen, Chi Pang; Liu, Chung Hsiang; Li, Jie Yuan; Jeng, Jiann Shing; Chen, Chih Hung; Lien, Li Ming; Lin, Ching Huang; Sun, Yu; Chang, Wei Lun; Hu, Chaur Jong; Hsu, Chung Y.

In: Journal of the American Heart Association, Vol. 7, No. 19, 02.10.2018, p. e009856.

Research output: Contribution to journalArticle

Chi, Nai Fang ; Wen, Chi Pang ; Liu, Chung Hsiang ; Li, Jie Yuan ; Jeng, Jiann Shing ; Chen, Chih Hung ; Lien, Li Ming ; Lin, Ching Huang ; Sun, Yu ; Chang, Wei Lun ; Hu, Chaur Jong ; Hsu, Chung Y. / Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data. In: Journal of the American Heart Association. 2018 ; Vol. 7, No. 19. pp. e009856.
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abstract = "Background Clopidogrel was thought to be superior to aspirin for secondary prevention of vascular diseases in clinical trials. In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real-world practice by using the Taiwan Stroke Registry. Methods and Results Patients with ischemic stroke (2006-2016) on aspirin or clopidogrel for secondary stroke prevention were identified in the Taiwan Stroke Registry. Stroke recurrence and mortality rates in patients receiving aspirin (N=34 679) were compared with those receiving clopidogrel (N=7611) during a 12-month follow-up period. Propensity score matching and conditional Cox proportional hazards regression model were applied to control confounding factors with 6443 patients in each group. After propensity score matching, stroke recurrence rates were comparable between groups, with 223 patients in the aspirin (3.46{\%}) and 244 in the clopidogrel group (3.79{\%}) (hazard ratio=1.13, 95{\%} confidence interval=0.89-1.43, P=0.311). However, the mortality rate was significantly higher in the clopidogrel group (362 patients, 5.62{\%}) than in the aspirin group (302 patients, 4.69{\%}) (hazard ratio=1.30, 95{\%} confidence interval=1.07-1.58, P=0.008). Results were consistent before and after propensity score matching. Conclusions Clopidogrel was as effective as aspirin for prevention of recurrent stroke in real-world practice. However, the mortality rate was significantly higher in the clopidogrel than in the aspirin group.",
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T1 - Comparison Between Aspirin and Clopidogrel in Secondary Stroke Prevention Based on Real-World Data

AU - Chi, Nai Fang

AU - Wen, Chi Pang

AU - Liu, Chung Hsiang

AU - Li, Jie Yuan

AU - Jeng, Jiann Shing

AU - Chen, Chih Hung

AU - Lien, Li Ming

AU - Lin, Ching Huang

AU - Sun, Yu

AU - Chang, Wei Lun

AU - Hu, Chaur Jong

AU - Hsu, Chung Y.

PY - 2018/10/2

Y1 - 2018/10/2

N2 - Background Clopidogrel was thought to be superior to aspirin for secondary prevention of vascular diseases in clinical trials. In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real-world practice by using the Taiwan Stroke Registry. Methods and Results Patients with ischemic stroke (2006-2016) on aspirin or clopidogrel for secondary stroke prevention were identified in the Taiwan Stroke Registry. Stroke recurrence and mortality rates in patients receiving aspirin (N=34 679) were compared with those receiving clopidogrel (N=7611) during a 12-month follow-up period. Propensity score matching and conditional Cox proportional hazards regression model were applied to control confounding factors with 6443 patients in each group. After propensity score matching, stroke recurrence rates were comparable between groups, with 223 patients in the aspirin (3.46%) and 244 in the clopidogrel group (3.79%) (hazard ratio=1.13, 95% confidence interval=0.89-1.43, P=0.311). However, the mortality rate was significantly higher in the clopidogrel group (362 patients, 5.62%) than in the aspirin group (302 patients, 4.69%) (hazard ratio=1.30, 95% confidence interval=1.07-1.58, P=0.008). Results were consistent before and after propensity score matching. Conclusions Clopidogrel was as effective as aspirin for prevention of recurrent stroke in real-world practice. However, the mortality rate was significantly higher in the clopidogrel than in the aspirin group.

AB - Background Clopidogrel was thought to be superior to aspirin for secondary prevention of vascular diseases in clinical trials. In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real-world practice by using the Taiwan Stroke Registry. Methods and Results Patients with ischemic stroke (2006-2016) on aspirin or clopidogrel for secondary stroke prevention were identified in the Taiwan Stroke Registry. Stroke recurrence and mortality rates in patients receiving aspirin (N=34 679) were compared with those receiving clopidogrel (N=7611) during a 12-month follow-up period. Propensity score matching and conditional Cox proportional hazards regression model were applied to control confounding factors with 6443 patients in each group. After propensity score matching, stroke recurrence rates were comparable between groups, with 223 patients in the aspirin (3.46%) and 244 in the clopidogrel group (3.79%) (hazard ratio=1.13, 95% confidence interval=0.89-1.43, P=0.311). However, the mortality rate was significantly higher in the clopidogrel group (362 patients, 5.62%) than in the aspirin group (302 patients, 4.69%) (hazard ratio=1.30, 95% confidence interval=1.07-1.58, P=0.008). Results were consistent before and after propensity score matching. Conclusions Clopidogrel was as effective as aspirin for prevention of recurrent stroke in real-world practice. However, the mortality rate was significantly higher in the clopidogrel than in the aspirin group.

KW - aspirin

KW - clopidogrel

KW - prevention

KW - stroke

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